CERTIFIED PROFESSIONAL IN HEALTH CARE RISK...

Conducted by the American Hospital Association Certification CenterEffective January 2020

CERTIFIED PROFESSIONAL IN HEALTH CARE RISK MANAGEMENTCANDIDATE HANDBOOK AND APPLICATION

2 CPHRM Candidate Handbook and Application

For questions regarding the certification programs, contact:

AHA Certification Center (AHA-CC)155 N. Wacker Drive, Suite 400Chicago, IL 60606Phone: 312-422-3702Fax: 312-422-4575Email: [email protected]: www.AHACertificationCenter.org

For questions regarding the examination application and administration, contact:

PSI18000 W. 105th St.Olathe, KS 66061-7543Phone: 888-519-9901Fax: 913-895-4651Email: [email protected]: www.goamp.com

CPHRM is a trademark of the AHA Certification Center, a division of the American Hospital Association.

Copyright © 2019 by the AHA Certification Center, a division of the American Hospital Association. All rights reserved. Any unauthorized reprint, use, distribution, or commercial exploitation of this material, in whole or in part, is strictly prohibited. No part of this publication may be stored, reproduced or transmitted in any form or by any means, electronic or mechanical, including copying, recording, or by any information storage and retrieval system without express written permission from the author/publisher. For information, contact the AHA Certification Center at [email protected].

3Copyright 2014 by the AHA Certification Center (rev. January 2019 )

The AHA-CC .................................................................................................................................. 5 Statement of Nondiscrimination ................................................................................................ 5

AHA-CC Certification Program Examinations ................................................................................. 5 Testing Agency ........................................................................................................................... 6

CPHRM Certification Program ....................................................................................................... 6 Definition of a Health Care Risk Management Professional ....................................................... 6

CPHRM Eligibility Requirements ............................................................................................. 6

CPHRM Examination .................................................................................................................... 7 CPHRM Examination Content Outline .................................................................................... 7

CPHRM Examination Preparation ................................................................................................ 11 Review the Content ................................................................................................................. 11

Complete the CPHRM Self-Assessment Examination .............................................................. 11

Use Other Study Resources ...................................................................................................... 11

CPHRM Examination Administration ........................................................................................... 11 Computer Administration at PSI Assessment Centers .............................................................. 12

Special Administration – Laptop or Paper-and-Pencil............................................................... 12

International Testing ................................................................................................................ 13

Special Arrangements for Candidates with Disabilities ............................................................ 13

Adhering To Professional Standards Of Conduct ............................................................................ 13

CPHRM Examination Application And Scheduling Process .......................................................... 14 CPHRM Examination Application Fee Schedule ..................................................................... 14

Online Application and Scheduling ......................................................................................... 15

Paper Application ..................................................................................................................... 16

Application Processing and CPHRM Examination Scheduling ................................................ 17

Rescheduling or Cancelling a CPHRM Examination ............................................................... 17

Table of Contents


On The Day Of The CPHRM Examination .................................................................................. 18 Failing to Report for the CPHRM Examination ...................................................................... 18

Reporting for the CPHRM Examination ................................................................................. 18

On-site Security ....................................................................................................................... 19

Identity Verification ................................................................................................................. 19

Use of Calculators .................................................................................................................... 19

Inclement Weather or Emergency ............................................................................................ 20

Taking The CPHRM Examination ................................................................................................. 20 Rules for CPHRM Examination .............................................................................................. 21

Copyrighted CPHRM Examination Questions ........................................................................ 23

Following The CPHRM Examination ............................................................................................ 23 CPHRM Examination Score Reports ....................................................................................... 23

How the CPHRM Examination Passing Score is Set ............................................................... 23

Passing the CPHRM Examination ........................................................................................... 24

Failing the CPHRM Examination ............................................................................................ 24

CPHRM Examination Scores Canceled by the AHA-CC ........................................................ 25

CPHRM Examination Score Confidentiality ........................................................................... 25

Administrative Matters ............................................................................................................. 25

Renewal Of CPHRM Certification ................................................................................................ 26 Failing to Renew CPHRM Certification .................................................................................. 27

Appeals .......................................................................................................................................... 27

CPHRM Examination Application ................................................................................................ 28

Request For Special Examination Accommodations Form .............................................................. 30

Documentation Of Disability-Related Needs ................................................................................. 31


CERTIFIED PROFESSIONAL IN HEALTH CARE RISK MANAGEMENTCANDIDATE HANDBOOK AND APPLICATION This Candidate Handbook provides information about the Certified Professional in Health Care Risk Management (CPHRM) program, including the exam administration policy and process as well as the CPHRM Examination Application. Keep this Candidate Handbook until after the CPHRM Examination is completed. Additional copies of this Candidate Handbook may be obtained by downloading a copy from www.AHACertificationCenter.org. The most current version of the Candidate Handbook is posted here and supersedes any other version.

THE AHA-CC The American Hospital Association Certification Center (AHA-CC) is a division of the American Hospital Association (AHA). Its mission is to create, facilitate and administer the health care industry’s premier certification programs.

Each Certification Program in development or operation with the AHA-CC has a Certification Program Committee that serves as content expert, program resource, and consultant to the AHA-CC regarding program development, CPHRM Examination content, test development, test administration and evaluation. Members are appointed by the AHA-CC Advisory Council

Statement of NondiscriminationThe AHA-CC does not discriminate among candidates on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, genetic information or any other legally protected group status.

AHA-CC CERTIFICATION PROGRAM EXAMINATIONSThe AHA-CC conducts certification examinations for programs in the following fields of health care: Facility Managers

Constructors

Environmental Services

Human Resources

Materials and Resource Management

Risk Management

Volunteer Resources Professionals

The AHA-CC also provides contracted project management and quality assurance services to the American Organization for Nursing Leadership (AONL) in support of its certification programs for nurse executives and nurse managers.

Each certification examination is designed to test a well-defined body of knowledge representative of professional practice in the discipline. Successful completion of a certification examination is an indicator of broad-based knowledge in the discipline being tested. Certification examinations conducted by the AHA-CC are independent of each other. Each leads to a certification credential in a health care discipline.


Content of each examination was defined by a national job analysis study. The study involved surveying practitioners in the field to identify tasks that are performed routinely and considered important to competent practice. Each edition of a certification examination is developed through a combined effort of qualified subject matter experts and testing professionals, who construct the examination in accordance with the Examination Content Outline.

Testing AgencyThe AHA-CC contracts with PSI to assist in the development, administration, scoring, score reporting and analysis of its CPHRM Examination.

CPHRM CERTIFICATION PROGRAMAdministered by the AHA-CC, the CPHRM certification program promotes health care risk management through certification of qualified individuals and the following program elements: Recognizing formally those individuals who meet the eligibility requirements of the AHA-CC

and pass the CPHRM Examination

Requiring certification renewal through continued personal and professional growth in the practice of health care risk management

Providing a national standard of requisite knowledge required for certification; thereby assisting employers, the public and members of health professions in assessing health care risk managers

Definition of a Health Care Risk Management ProfessionalThe Health Care Risk Management Professional’s primary duties include the prevention, reduction, and control of loss to the health care organization, its patients, visitors, volunteers, physicians, other health care professionals and employees. Regardless of the health care delivery system in which the individual works, the Health Care Risk Management Professional interfaces with a number of health care professionals in the accomplishment of these objectives. Duties may include incident investigation and analysis, tracking, trending and evaluation, risk financing and claims management.

CPHRM Eligibility RequirementsCandidates meeting the CPHRM eligibility requirements fully and passing the CPHRM Examination attain the CPHRM designation. The AHA-CC reserves the right, but is not obligated, to verify the accuracy of eligibility information supplied by or on behalf of a candidate.

To be eligible for the Certified Professional in Health Care Risk Management (CPHRM) Examination, a candidate must fulfill one of the following requirements for education/health care experience and meet the requirement for risk management experience.

Education/Health Care Experience Baccalaureate degree or higher from an accredited college or university plus five years of

experience in a health care setting or with a provider of services to the health care industry


Associate degree or equivalent from an accredited college plus seven years of experience in a health care setting or with a provider of services to the health care industry.

High school diploma or equivalent plus nine years of experience in a health care setting or with a provider of services to the health care industry.

Risk Management Experience 3,000 hours or 50 percent of full-time job duties within the last three years dedicated to health

care risk management in a health care setting or with a provider of services (e.g. consultant, broker, or attorney) to the health care industry.

CPHRM EXAMINATIONThe CPHRM Examination is structured as follows: Composed of 110 multiple-choice questions. A candidate’s score is based on 100 of these

questions. Ten items are “trial” or “pretest” questions that are interspersed throughout the Examination and are not scored.

A candidate is allowed two hours in which to complete the CPHRM Examination.

The CPHRM Examination is based on the five major content areas listed in the Content Outline.

- Each content area is further defined in the Content Outline by a list of tasks representative of that job responsibility.

- The number of CPHRM Examination questions devoted to each major content area is included in the Content Outline.

CPHRM Examination Content Outline For the CPHRM Examination Content Outline for the current CPHRM Examination, refer to the following pages.


American Hospital AssociationCertified Professional in Healthcare Risk Management

Examination Specifications*

Total # o

f items

1. Clinical/Patient Safety 25

A. Assess the current state of patient safety and staff awareness within the organization B. Collaborate on proactive patient safety initiatives (e.g., FMEA, Safety Culture/Just Culture) C. Design, implement, and maintain educational programs on risk management and patient safety

related topics D. Promote a culture of patient safety through education, policy development, and standardization

of processes E. Educate providers, staff, employees, patients and families on the role of patients and families in

improving patient safety and reducing riskF. Coach physicians, leaders, managers, and staff on appropriate disclosure methods and processesG. Participate in critical incident debriefingH. Participate in the development of corrective action plans and supervise follow-up of

recommended improvements (e.g., stemming from risk assessments/audits and investigations of reported incidents)

I. Provide guidance to staff regarding any of the following: 1. disruptive patient, family member and/or visitors 2. informed consent 3. substitute (Surrogate) Decision Makers 4. minors consent 5. release of information (e.g., law enforcement, subpoenas, attorneys, search warrants, etc.) 6. abuse allegations 7. advance directives/orders for life sustaining treatmentJ. Manage an incident reporting and data analysis system for patient safety, patient complaints, and

other risk eventsK. Provide risk management consultation for specific ethical dilemmasL. Maintain awareness of patient safety initiatives occurring locally and nationallyM. Review documentation and assist providers/staff with appropriate documentation to mitigate risk

2. Risk Financing 15

A. Manage a broad comprehensive insurance program including such activities as captive management, insurance, insurance purchasing, insurance consulting, administering self-insured coverages and managing or coordinating the management of claims for all lines of insurance

B. Oversee the investigation of accidents or circumstances that could lead to financial loss (e.g., professional, institutional, general liability, and product liability)

C. Analyze historical loss experience; address trendsD. Develop enterprise risk financing strategies to address the organization’s areas of exposure (e.g.,

general liability (GL), professional liability (PL), cyber liability)E. Provide recommendations to reduce risk in contracts, ensuring adequate controls and obligations

for insurance coverage are appropriate to the riskF. Ensure timely reporting of incidents according to insurance policy language




Total # o

f items

3. Legal and Regulatory 20

A. Promote compliance with federal and state laws and regulations through policy development, guidance, or education

B. Promote compliance with federal and state laws and regulations governing patient confidentiality through policy development, guidance, or education including protected health information (PHI)

C. Promote compliance with federal and state reporting requirements through policy development, guidance, or education (e.g., abuse of vulnerable populations)

D. Promote compliance with federal and state reporting requirements governing violence in the workplace through policy development, guidance, or education

E. Promote compliance with federal and state regulations/organization policy regarding the investigation and resolution of patient complaints or grievances through policy development, guidance, or education

F. Collaborate with other departments by preparing and conducting quality and/or risk assessments to maintain a constant state of accreditation readiness

G. Promote compliance with laws and regulations governing involuntary detention of patients through policy development, guidance, or education

H. Promote compliance with the requirements of the following federal acts/regulations through policy development, guidance, or education:

1. Centers for Medicare and Medicaid Services (CMS) 2. Emergency Medical Treatment and Active Labor Act (EMTALA/COBRA) 3. Health Insurance Portability and Accountability Act (HIPAA) 4. National Practitioner Data Bank (NPDB) 5. Safe Medical Device Act (SMDA)I. Design a risk management data collection/analysis system to ensure timely reporting and

monitoring of: 1. device reporting and tracking logs 2. regulatory inquiries 3. Collaborate in the development of the organization’s regulatory compliance plan to ensure

workforce compliance of all applicable accreditation standards 4. Promote, in partnership with Patient Safety and Medical Staff departments, programs

that address provider and staff behavioral issues are culturally, legally and psychologically sound and non-discriminatory

5. Participate in the development of responses to inquiries from regulatory and licensing agencies, and insurance companies




Total # o

f items

4. Healthcare Operations 20

A. Collaborate with leaders and security personnel on workplace violence preventionB. Conduct risk assessments to identify exposures related to new and existing services and enterprise-

wide services C. Establish a method for planning, evaluating, selecting, management, and on-going evaluation of

enterprise wide event reports of harm or near-harm incidentsD. Supervise and develop risk management staffE. Develop/maintain risk management department specific policies and procedures and modify as

requiredF. Coordinate risk activities for the organization G. Develop annual institutional goals for the risk program/departmentH. Evaluate the effectiveness of risk management activitiesI. Develop policies and procedures for acceptance of legal documents (e.g., summons, complaints,

subpoenas, court orders)J. Support patient safety committee meetings by collecting and formulating relevant information to

facilitate decision-making processK. Participate in professional association activitiesL. Understand the peer review, credentialing and privileging processM. Provide education/in-service for staff, patients, families, communities on patient’s rights

(e.g., end of life decisions)N. Collaborate on the development of policies and procedures which provide direction to the

organization on topics which have a significant degree of risk (e.g. Privacy, Informed Consent, Infection Prevention, Documentation, Telemedicine, etc.)

5. Claims and Litigation 20

A. Maintain data collection and analysis systems including elements of reports of Potential Compensatory Events (PCEs), open and closed claims and loss runs

B. Notify carriers and/or third-party claims and litigation department or administrators of potential compensatory events or actual claims

C. Participate in claims management activities (e.g., assignment of counsel, setting loss reserves, respond to discovery requests/interrogatories, preparation and attendance for depositions, mediation, arbitration, and trials, evidence/record preservation and management, review and approve legal expenses)

D. Participate in evaluating claims to determine exposure to organization and the appropriate method for resolution

E. Inform administration of high exposure cases and aggregate claims experience, including any impact to the risk financing program

F. Manage and maintain all information related to a potential or actual legal case under attorney/client privilege and protected from discoverability

G. Manage the response to service of process and notify appropriate parties of such serviceH. Support insured defendants through all phases of the litigation process


CPHRM EXAMINATION PREPARATION The method of preparation and amount of time spent preparing for the AHA-CC certification Examinations can be driven by the candidate’s preferred study style, level of professional experience or academic background. Some methods of preparation may include but are not limited to the following methods.

Review the ContentCandidates who have passed the AHA-CC certification examinations report that study should begin by reviewing the Examination Content Outline. Review the content categories and related tasks. Identify and focus review on tasks that you do not perform regularly or with which you are not familiar. Remember that all questions in the CPHRM Examination are job-related/experience-based and test the application and analysis of information, not just the recollection of isolated facts.

Complete the CPHRM Self-Assessment Examination (SAE) A Self-Assessment Examination (SAE) for the CPHRM Examination is an online tool created by the AHA-CC to simulate the CPHRM Examination. This tool is available for purchase at www.AHACertificationCenter.org.

The 100-question online practice test was developed using the same procedures as the CPHRM Examination, and conforms to CPHRM Examination specifications in content, format, and difficulty. Feedback reports from the SAE provide an opportunity to evaluate and remedy less-than-desirable performance before taking the CPHRM Examination. The questions presented in the SAE are different from the questions contained on the CPHRM certification Examination. Performance on the CPHRM SAE is not necessarily an indicator of performance on the CPHRM Certification Examination.

Use Other Study ResourcesThe AHA-CC recommends that review for the CPHRM Examination focus on references and programs that cover the information summarized in the CPHRM Examination Content Outline. It should not be inferred that questions in the CPHRM Examination are selected from any single reference or set of references, or that study from specific references guarantees a passing score on the CPHRM Examination. For information about references, study guides and review sessions offered by the American Society for Health Care Risk Management (ASHRM), visit www.ASHRM.org.

CPHRM EXAMINATION ADMINISTRATION The CPHRM Examination is administered in the following ways: On computers at PSI Assessment Centers

During special administrations at conferences, meetings or other specially-arranged sessions

Outside of the U.S. on request and for an additional fee


In accordance with the Americans with Disabilities Act (ADA), special arrangements can be made for candidates with a disability.

Computer Administration at PSI Assessment CentersThe primary mode of delivery of the CPHRM Examination is via computer at over 250 PSI Assessment Centers geographically distributed throughout the United States. For PSI Assessment Center locations, detailed maps and directions, go to www.AHACertificationCenter.org, click on “CPHRM” and then on “Testing Centers.”

For computer administrations at PSI Assessment Centers, a candidate who meets eligibility requirements for the CPHRM Examination may submit an application and fee at any time. A candidate must make an appointment to take the CPHRM Examination within 90 days from confirmation of eligibility from PSI. The CPHRM Examination is administered by appointment only Monday through Saturday at 9:00 a.m. and 1:30 p.m., with the exception of some holidays. Candidates are scheduled on a first-come, first-served basis.

If PSI is contacted by 3:00 p.m. CST: Depending upon availability, the examination

may be scheduled as early as:

Monday Wednesday

Tuesday Thursday

Wednesday Friday/Saturday

Thursday Monday

Friday Tuesday

The CPHRM Examination is not offered on the following holidays. New Year’s Day Martin Luther King, Jr. Day Presidents’ Day Good Friday Memorial Day Independence Day (July 4) Labor Day

Columbus Day Veterans’ Day Thanksgiving Day and the

following Friday Christmas Eve Day Christmas Day New Year’s Eve Day

Special Administration – Laptop or Paper-and-Pencil The CPHRM Examination may be offered on laptop or in paper-and-pencil format during conferences or meetings. A candidate who meets the CPHRM eligibility requirements and submits a CPHRM Examination application and fee for receipt by the posted deadline is allowed to take the CPHRM Examination. Online application is not available for special administrations. Dates of special administrations and deadlines for receipt of applications are posted on www.AHACertificationCenter.org.


International TestingCandidates who are eligible for the CPHRM Examination and wish to take the CPHRM Examination outside of the U.S. may be accommodated by submitting a Request for International Examination Administration form. To obtain the form, go to www.AHACertificationCenter.org. Please note that an additional fee may apply.

Special Arrangements for Candidates with DisabilitiesThe AHA-CC complies with applicable provisions of the Americans with Disabilities Act (ADA) and strives to ensure that no individual with a disability is deprived of the opportunity to take the CPHRM Examination solely by reason of that disability. Through its agents, the AHA-CC will provide reasonable accommodation for a candidate with a disability who requests accommodation by completing and timely submitting the Request for Special Examination Accommodations form included in this Candidate Handbook to PSI.

PSI Assessment Centers are equipped with Telecommunication Devices for the Deaf (TDD) to assist deaf and hearing-impaired candidates. TDD calling is available 8:30 a.m. to 5:00 p.m. (CST) Monday through Friday at 913/895-4637. This TDD phone option is for individuals equipped with compatible TDD machinery. Additionally, wheelchair access is available at all PSI Assessment Centers.

A candidate with a visual, sensory or physical disability that prevents taking the CPHRM Examination under standard conditions may request special accommodations and arrangements. For either a computer or a special administration of a CPHRM Examination, complete the Request for Special Examination Accommodations form included in this Candidate Handbook and submit it with a CPHRM Examination application and fee at least 45 days prior to the CPHRM Examination date desired.

ADHERING TO PROFESSIONAL STANDARDS OF CONDUCTThe AHA-CC is responsible to its candidates, certificants, employers, the profession and the public for ensuring the integrity of all processes and products of its Certification Programs. As such, the AHA-CC requires adherence to these Professional Standards of Conduct by all who have achieved certification through successful completion of its programs. A candidate’s signature on the CPHRM Examination Application attests to ongoing agreement to adhere to the following Professional Standards of Conduct.

Professional Standards of Conduct. A certificant who is awarded certification by the AHA-CC agrees to conduct himself/herself in an ethical and professional manner. This includes demonstrating practice-related behavior that is indicative of professional integrity. By accepting certification, the certificant agrees to the following: Maintain professional competence

Demonstrate work behavior that exemplifies ability to perform safely, competently and with good judgment


Conduct professional activities with honesty and integrity

Avoid discriminating against any individual based on age, gender, race, color, religion, national origin, disability or marital status

Avoid conflicts of interest

Abide by the laws, rules and regulations of duly authorized agencies regulating the profession

Abide by rules and regulations governing programs conducted by the AHA Certification Center

Not to misrepresent the credential and to adhere to the Guidelines for Use of the Certification Marks as posted on the AHA-CC website.

Infraction of the Professional Standards of Conduct is misconduct for which granting of a certification or renewal of a certification may be delayed or denied, or for which a certification may be revoked by the AHA Certification Center.

Reporting Violations. To protect the national credentials and to ensure responsible practice by its certificants, the AHA-CC depends upon its candidates and certificants, professionals, employers, regulatory agencies and the public to report incidents that may be in violation of these Professional Standards of Conduct. A certificant who has violated these Standards should voluntarily surrender his/her certification.

Written reports of infraction of these Standards may be sent to: AHA Certification Center, 155 N. Wacker Drive, Suite 400, Chicago, IL 60606. Only signed, written communication will be considered.

The AHA-CC will become involved only in matters that can be factually determined, and commits to handling any situation as fairly and expeditiously as possible. During its investigation and decision, the AHA Certification Center will protect the confidentiality of those who provide information to every possible extent. The named individual will be afforded a reasonable opportunity to respond in a professional and legally defensible manner, in accordance with policies established by the AHA-CC.

CPHRM EXAMINATION APPLICATION AND SCHEDULING PROCESSCPHRM Examination Application Fee Schedule After fulfilling the CPHRM eligibility requirements, a candidate may apply to PSI for the CPHRM Examination in one of the following ways. Online Application (available at www.goamp.com; requires credit card payment for fees.)

Paper Application (included in this Candidate Handbook)

Documentation of eligibility does not need to be submitted with a CPHRM Examination Application. The AHA-CC reserves the right, but is not obligated, to verify the accuracy of information supplied by or on behalf of a candidate. If selected for an audit, the candidate may be asked to submit documentation as proof of meeting the eligibility requirements.


To apply for the CPHRM Examination, an eligible candidate must submit the appropriate fee (see below) with a complete CPHRM Examination Application to PSI.Member of ASHRM or other AHA Professional Membership Group .............. $275Nonmember .................................................................................................... $425

Payment may be made by credit card (VISA, MasterCard, American Express or Discover) or by company check, cashier’s check or money order made payable to PSI. Cash and personal checks are not accepted.

Examination-related fees are nonrefundable and nontransferable.

Up to two business days prior to a scheduled administration, the application may be transferred to a future CPHRM Examination date by requesting PSI to reschedule a new date. The examination date may be rescheduled once without incurring an additional fee. This date must be within 90 days of PSI confirming receipt of your CPHRM Examination application. Each additional rescheduling of a CPHRM examination date is subject to a $100 rescheduling fee.

Credit card transactions that are declined are subject to a $25 handling fee. A certified check or money order for the amount due, including the handling fee, must be submitted to PSI to cover declined credit card transaction.

Candidates who fail a CPHRM Examination and apply to retake the CPHRM Examination must pay the full CPHRM Examination fee as listed above.

Online Application and SchedulingFor computer administrations at PSI Assessment Centers onlyComplete the CPHRM Examination application and scheduling process in one online session. Visit www.AHA.org/certification, click on “CPHRM,” click on “Where can I take the exam?,” and then follow the online instructions.

If you are a current member of an AHA Professional Membership Group (PMG), you are eligible for the reduced AHA member rate for CPHRM Examination fee. Click on “Member,” and enter your membership number, name and address exactly as they appear in AHA’s membership database.

Your preferred mailing and email addresses designated in AHA’s membership database are used for all records and communications. For information on your membership record, please contact ASHRM at 312-422-3980 or AHA’s Member Services Center at 312-422-2765.

After completing the CPHRM Examination application and submitting credit card payment information (VISA, MasterCard, American Express, Discover), PSI confirms the candidate’s certification of eligibility, and prompts the candidate to schedule a CPHRM Examination appointment or supply additional eligibility information. The candidate must schedule a CPHRM Examination date that is within 90 days of PSI confirming receipt of the CPHRM Examination application.


Paper ApplicationFor all administrationsComplete and submit to PSI a CPHRM Examination application with the appropriate fee. You may complete the paper application included in this Candidate Handbook or obtained by one of the following ways: Downloading copy from www.AHACertificationCenter.org

Contacting PSI at 888-519-9901

An incomplete CPHRM Examination Application will be returned to the candidate along with any fee submitted less a $50 processing fee. A CPHRM Examination application is considered complete only if all of the following conditions are met: Information provided is legible and accurate. All of the following required information is provided: - Personal Information

- Examination Type (For a special domestic administration, list the scheduled date. Administration and application deadline dates are posted on www.aha.org/certification).

- Application Status

- Membership Status (Eligibility for the Member rate of the CPHRM Examination Application fee requires recording your membership number, name, and address exactly as they appear in AHA’s membership database. For information on your member record, contact ASHRM at 312-422-3980 or AHA’s Member Service Center at 312-422-2765).

- Method of payment for the applicable fee

- Demographic information

- Signature

The candidate is eligible for the CPHRM Examination and can provide evidence if requested to do so.

Appropriate fee accompanies the application (credit card, company check, cashier’s check or money order).

If you are an AHA Professional Membership Group (PMG) member, you must provide your member number to PSI. This will be your identification number. If you are not a member of an AHA PMG, please indicate such and PSI will assign a unique identification number.

If special accommodations are required, complete and submit to PSI the Request for Special Examination Accommodations form included in this Candidate Handbook and submit with the CPHRM Examination application and fee to PSI at least 45 days prior to the desired testing date.


Application Processing and CPHRM Examination SchedulingApplications may take up to two weeks to process. Once eligibility is confirmed, PSI will send candidates their confirmation notice by email and postcard with instructions on scheduling a testing appointment online or by phone. If a confirmation notice is not received within four weeks of mailing your application, contact PSI at 888-519-9901.

When scheduling a CPHRM Examination at a PSI Assessment Center, be prepared to confirm a location and a preferred date and time for testing. If you are an AHA Professional Membership Group (PMG) member, you must provide your member number to PSI. This will be your identification number. If you are not a member of an AHA PMG, please indicate such and PSI will assign a unique identification number.

For a computer administration at a PSI Assessment Center, a candidate’s application is valid for 90 days from the date PSI confirms receipt of the application. The candidate must schedule an appointment and take the CPHRM Examination within this 90 day period. A candidate who fails to schedule an appointment within the 90 day period forfeits the application and all fees paid to take the CPHRM Examination. A complete application and full examination fee are required to reapply for CPHRM Examination.

For special administrations, approximately ten business days after PSI’s receipt of application, a notice is sent by email to the candidate stating the application has been received and approved. If the application is incomplete, a letter will be sent to the candidate listing the deficiency. Generally, candidates receive their admission letter to the testing about two to three weeks prior to the CPHRM special administration date. The notice includes the date, location and check-in time for the CPHRM Examination.

A candidate is allowed to take only the CPHRM Examination for which application is made and confirmation from PSI is received. Unscheduled candidates (walk-ins) are not allowed to take the CPHRM Examination.

Rescheduling or Canceling a CPHRM ExaminationAlthough CPHRM Examination application fees are nonrefundable, a candidate who is unable to take the CPHRM Examination has the following options to reschedule a CPHRM Examination: A candidate may reschedule the CPHRM Examination once at no charge by calling PSI

at 888-519-9901 at least two business days prior to a scheduled administration date. The CPHRM Examination must be rescheduled within 90 days of the originally scheduled CPHRM Examination date.

A candidate may reschedule a second or additional time by submitting to PSI a written request including their name, address, identification number and the $100 rescheduling fee. A new CPHRM Examination application is not required. The CPHRM Examination must be rescheduled within 90 days of the originally scheduled CPHRM Examination date. For payment by credit card, the credit card number, and expiration date must be included.


A candidate who reschedules a CPHRM Examination after the 90-day period forfeits the application and all fees paid to take the exam. A new, complete application and full CPHRM Examination fee are required to reapply for the CPHRM Examination.

A candidate who cancels a CPHRM Examination after confirmation of eligibility is received from PSI forfeits the application and all fees paid to take the CPHRM Examination. A new, complete application and full CPHRM Examination fee are required to reapply for the CPHRM Examination.

ON THE DAY OF THE CPHRM EXAMINATION Failing to Report for the CPHRM ExaminationA candidate who shows up late or fails to show up for an already rescheduled exam without the requisite advance two business days’ notice forfeits all fees. A complete application and the full CPHRM Examination fee are required to reschedule another CPHRM Examination.

A candidate who fails to report for a scheduled CPHRM Examination with the required advance notice has the following two options: Reschedule the CPHRM Examination for a new date that is within 90 days from the originally

scheduled testing date and remit the $100 rescheduling fee. To schedule a new appointment for the CPHRM Examination, the candidate must submit to PSI a written request including their name, address, identification number, and rescheduling fee. For payment by credit card, the credit card number, and expiration date must be included. A new CPHRM Examination application is not required.

Reschedule the CPHRM Examination date for a date that is beyond the 90 day period and forfeit the application and all fees paid to take the exam. A complete application and full CPHRM Examination fee are required to reapply for the CPHRM Examination.

Reporting for the CPHRM ExaminationBring with you the confirmation notice provided by PSI. It contains the unique identification number required to take the test and is required for admission to the testing room.

For a computer administration, report to the PSI Assessment Center no later than the scheduled testing time. After entering the H&R Block office, follow the signs indicating PSI Assessment Center Check-In.

For a special administration (laptop or paper-and-pencil), report to the designated testing room at the time indicated on the confirmation notice. The CPHRM Examination will begin after all scheduled candidates are checked-in and seated and no more than one hour after the scheduled registration begins. Follow the signs provided in the hotel/convention center to locate the testing room.

A candidate who arrives more than 15 minutes after the scheduled testing time is not admitted. A candidate who is not admitted due to late arrival must reschedule the CPHRM Examination

for a new date that is within 90 days from the originally scheduled testing date and remit the


$100 rescheduling fee. To schedule a new appointment for the exam, the candidate must submit to PSI a written request including their name, address, identification number and rescheduling fee. For payment by credit card, the credit card number, and expiration date must be included. A new examination application is not required.

A candidate who does not reschedule a CPHRM Examination session that is within the 90 day period forfeits the application and all fees paid. A complete application and full exam fee are required to reapply for the exam.

On-site Security The AHA-CC and PSI maintain CPHRM Examination administration and security standards that are designed to assure that all candidates are provided the same opportunity to demonstrate their abilities. The testing environment at PSI Assessment Centers is continuously monitored by audio and video surveillance equipment or CPHRM Examination personnel. Candidates may be subjected to a metal detection scan upon entering the examination room.

Identity VerificationTo gain admission to the PSI Assessment Center or a testing room, the candidate must present two forms of identification. The primary form must be government issued, current, and include the candidate’s name, signature and photograph. The candidate will also be required to sign a roster for verification of identity. A candidate without proper identification will not be permitted to take the CPHRM Examination. Examples of valid primary forms of identification are current driver’s license with photograph,

current state identification card with photograph, current passport, or current military identification card with photograph.

The secondary form of identification must display the candidate’s name and signature for the candidate’s signature verification. (e.g., credit card with signature, social security card with signature, employment/student ID card with signature, etc.)

If the candidate’s name on the registration list is different than it appears on the forms of identification, the candidate must bring proof of the name change (e.g., marriage license, divorce decree, or court order).

No form of temporary identification will be accepted.

Use of CalculatorsSome CPHRM Examination questions may require calculations. Use of a silent, nonprogrammable calculator without paper tape-printing capability or alpha keypad is permitted during the CPHRM Examination. Use of a computer or a cell phone is not permitted. Calculators will be checked for conformance with this regulation before candidates are allowed admission to the PSI Assessment Center or testing room. Calculators that do not comply with to these specifications are not permitted in the PSI Assessment Center or testing room.


Inclement Weather or EmergencyIn the event of inclement weather or unforeseen emergencies on the day of the CPHRM Examination, the AHA-CC, in concert with PSI, will determine whether circumstances warrant the cancellation and subsequent rescheduling of a CPHRM Examination. If testing personnel are able to conduct business, the CPHRM Examination usually proceeds as scheduled.

Every attempt is made to administer a CPHRM Examination as scheduled; however, should a CPHRM Examination be canceled, the scheduled candidate will receive notification following the CPHRM Examination regarding a rescheduled CPHRM Examination date or reapplication procedures. In the case of cancellation, no additional fee is required to take the CPHRM Examination.

For computer administrations at PSI Assessment Centers, candidates may visit PSI’s website at www.goamp.com prior to the CPHRM Examination to determine if any PSI Assessment Centers have been closed.

In the event of a personal emergency on the day of the CPHRM Examination, a candidate may request consideration of rescheduling the CPHRM Examination without additional fee by contacting the AHA-CC in writing within 30 days of the scheduled testing session. A description of the emergency and supporting documentation are required. Rescheduling without additional fee will be considered on a case-by-case basis.

TAKING THE CPHRM EXAMINATION After identity of the candidate has been verified and his/her calculator has been approved, the candidate is directed to a testing carrel for a computer administration or an assigned seat for a special administration. For computer-based testing, including laptop administrations, each candidate is provided one sheet of scratch paper for calculations that must be returned to the CPHRM Examination proctor at the completion of testing.

For a paper-and-pencil administration, the candidate is provided oral and written instructions about the CPHRM Examination administration process.

For a computer administration at a PSI Assessment Center or a laptop administration, the candidate is provided instructions on-screen. First, the candidate is instructed to enter his/her unique identification number. Then, the candidate’s photograph is taken and remains on-screen throughout the CPHRM Examination session. Prior to attempting the CPHRM Examination, the candidate is provided a short tutorial on using the software to take the CPHRM Examination. Tutorial time is NOT counted as part of the two hours allowed for the CPHRM Examination. Only after a candidate is comfortable with the software and choses to do so does the CPHRM Examination begin.

The computer monitors the time spent on the CPHRM Examination. The CPHRM Examination terminates at the two-hour mark. Clicking on the TIME button in the lower right portion of the screen reveals a digital clock that indicates the time remaining. The TIME feature may also be turned off during the CPHRM Examination.


Only one CPHRM Examination question is presented at a time. The question number appears in the lower right portion of the screen. The entire CPHRM Examination question appears on-screen (stem and four options labeled A, B, C and D). Select an answer either by entering the letter of the option (A, B, C or D) or using the mouse to click on the option. The letter of the selected option appears in the window in the lower left portion of the screen. To change an answer, enter a different option by pressing the A, B, C or D key or by clicking on the option using the mouse. An answer may be changed multiple times.

To move to the next question, click on the forward arrow (>) in the lower right corner of the screen. This action allows the candidate to move forward through the CPHRM Examination question by question. To review a question or questions, click the backward arrow (<) or use the left arrow key to move backward through the CPHRM Examination.

A CPHRM Examination question may be left unanswered for return later in the testing session. Questions may also be bookmarked for later review by clicking in the blank square to the right of the TIME button. Click on the hand icon to advance to the next unanswered or bookmarked question on the CPHRM Examination. To identify all unanswered or bookmarked questions, repeatedly click on the hand icon.

When the CPHRM Examination is completed, the number of CPHRM Examination questions answered is reported. If fewer than 110 questions were answered and time remains, return to the CPHRM Examination and answer the remaining questions. Be sure to answer each CPHRM Examination question before ending the CPHRM Examination. There is no penalty for guessing.

Candidates may provide comments about a test item. Comments will be reviewed, but individual responses will not be provided. For a computer administration, online comments may be provided for any question by clicking

on the button displaying an exclamation point (!) to the left of the TIME button. This opens a dialogue box where comments may be entered.

For a paper-and-pencil administration, comments may be provided on the answer sheet on the day of the CPHRM Examination.

Rules for CPHRM ExaminationAll CPHRM Examination candidates must comply with the following rules during the CPHRM Examination administration:1. No personal items (including watches, hats, and coats), valuables or weapons should be brought

into the testing room. Only keys, wallets, and items required for medical needs are permitted. Books, computers, or other reference materials are strictly prohibited. If personal items are observed in the testing room after the examination is started, the exam administration will be forfeited. PSI is not responsible for items left in the reception area.

2. Pencils will be provided during check-in. No personal writing instruments are allowed in the testing room.


3. CPHRM Examinations are proprietary. CPHRM Examination questions may not be recorded or shared with any individual in any manner. No cameras, notes, tape recorders, pagers, cellular/smart phones, or other recording devices are allowed in the testing room. Possession of a cellular/smart phone or other electronic devices is strictly prohibited and will result in dismissal from the CPHRM Examination.

4. Eating, drinking, and smoking is not permitted in the testing room.

5. No documents or notes of any kind may be removed from the testing room. Each CPHRM candidate will be provided one sheet of scratch paper that must be returned to the CPHRM Examination proctor at the completion of testing.

6. No questions concerning the content of the CPHRM Examination may be asked of anyone during the CPHRM Examination.

7. Permission from the CPHRM Examination proctor is required to leave the testing room during the exam. No additional time is granted to compensate for time lost.

8. No guests, visitors, or family members are allowed in the testing room or reception areas.

Candidates observed engaging in any of the following conduct during the CPHRM Examination may be dismissed from the CPHRM Examination session, their score on the CPHRM Examination voided and the CPHRM Examination fees forfeited. Evidence of misconduct is reviewed by the Appeal Board of the AHA-CC to determine whether the CPHRM candidate will be allowed to reapply for CPHRM Examination. If re-examination is granted, a complete CPHRM Examination application and full CPHRM Examination fee are required. Gaining unauthorized admission to the CPHRM Examination

Creating a disturbance, being abusive or otherwise uncooperative

Displaying and/or using electronic communications equipment including but not limited to pagers, cellular/smart phones, etc.

Talking or participating in conversation with other CPHRM Examination candidates

Giving or receiving help or being suspected of doing so

Leaving the PSI Assessment Center or testing room during the CPHRM Examination

Attempting to record CPHRM Examination questions in any manner or making notes

Attempting to take the CPHRM Examination for someone else

Having possession of personal belongings

Using notes, books, or other aids without it being noted on the roster

Attempting to remove CPHRM Examination materials or notes from the PSI Assessment Center or the testing room


Copyrighted CPHRM Examination QuestionsAll CPHRM Examination questions are the copyrighted property of the AHA-CC. It is forbidden under federal copyright law to copy, reproduce, record, distribute or display these CPHRM Examination questions by any means, in whole or in part. Doing so may result in severe civil and criminal penalties.

FOLLOWING THE CPHRM EXAMINATION CPHRM Examination Score ReportsScore reports are issued by PSI, on behalf of the AHA-CC. Scores are reported in written form only, in person or by U.S. mail. Scores are not reported over the telephone, by electronic mail or by facsimile. A candidate who takes the CPHRM Examination in paper-and pencil format receives his/her

score report from PSI by mail generally about three to five weeks after the CPHRM Examination.

A candidate who takes the CPHRM Examination on a computer at a PSI Assessment Center or on laptop receives his/her score report before leaving the testing center except when the CPHRM Examination program is in a provisional score report mode.

The score report indicates a “Pass” or “Fail”, which is determined by the raw score on the CPHRM Examination. The score report also includes raw scores for each of the major categories of the CPHRM Examination Content Outline. A raw score is the number of questions answered correctly. Responses to individual CPHRM Examination questions will not be disclosed to the candidate. Even though the CPHRM Examination consists of 110 questions, the CPHRM Examination score is based on 100 questions. Ten questions are “pretest” questions and do not impact the candidate’s score. The minimum passing score for the CPHRM Examination is posted on http://www.AHACertificationCenter.org/index.shtml .

Recognition of certification and information about certification renewal are issued from the AHA-CC generally about four to six weeks of successfully completing the CPHRM Examination. This package is mailed to the address contained in the AHA member database.

How the CPHRM Examination Passing Score Is SetThe methodology used to set the initial minimum passing score is the Angoff method in which expert judges estimate the passing probability of each question on the CPHRM Examination. These ratings are averaged to determine the preliminary minimum passing score (i.e., the number of correctly answered questions required to pass the CPHRM Examination). This method takes into account the difficulty of the CPHRM Examination. The preliminary minimum passing score is validated by the performance of candidates. The passing standard is applied consistently across all candidates who take the same form of the CPHRM Examination.


When new forms of the CPHRM Examination are introduced, a certain number of CPHRM Examination questions in the various content areas are replaced by new CPHRM Examination questions. These changes may cause one form of the CPHRM Examination to be slightly easier or harder than another form. To adjust for these differences in difficulty, a procedure called “equating” is used. For equated CPHRM Examinations that have different passing scores, the equating process helps ensure that the levels of examinee knowledge are equivalent on the various CPHRM Examination forms.

Passing the CPHRM ExaminationAn eligible candidate who passes the CPHRM Examination is awarded the Certified Professional in Health Care Risk Management (CPHRM) credential. Generally about four to six weeks after the candidate passes a CPHRM Examination, the AHA-CC mails to the candidate a certificate of recognition, a pin and information about CPHRM certification renewal requirements. The name on the certificate and the address to which the package is mailed is based on information in the candidate’s membership record. It is the candidate’s responsibility to keep current this information.

The AHA-CC, in concert with the Professional Membership Group (PMG), reserves the right to recognize publicly any candidate who has successfully completed the CPHRM Examination. Recognition is awarded so as not to embarrass any candidate who is not successful in achieving certification.

Name, address, telephone number and email address of a candidate who passes the CPHRM Examination will be shared with the PMG. Scores are never reported. If you do NOT wish to have your personal information shared, please opt out by contacting the AHA-CC in writing via e-mail at [email protected] or fax at 312-422-4575.

Failing the CPHRM ExaminationIf a candidate does not pass the CPHRM Examination, the score report includes a shortened application form to apply for retaking the exam. To schedule a retake of the CPHRM Examination, a candidate may apply by using the online

application and scheduling feature on www.AHACertificationCenter.org or by submitting the re-application form included with the score report. To use this shortened application form, the completed application and full CPHRM Examination fee must be submitted and a CPHRM Examination scheduled within the 90-day period following the failed CPHRM Examination.

A candidate who applies to retake the CPHRM Examination after 90 days following the failed CPHRM Examination date must submit a completed full-length application (in this CPHRM Handbook or on-line at goamp.com) and full examination fee.

There is no limit to the number of times an individual may take the CPHRM Examination. Every retake requires submitting a CPHRM Examination application and the full CPHRM Examination fee.


CPHRM Examination Scores Cancelled by the AHA-CCThe AHA-CC and PSI are responsible for maintaining the integrity of the scores reported. On occasion, occurrences such as computer malfunction or misconduct by a candidate may cause a score to be suspect. The AHA-CC is committed to rectifying such discrepancies as expeditiously as possible. The AHA-CC may void CPHRM Examination results if, upon investigation, violation of CPHRM Examination regulations is discovered.

CPHRM Examination Score Confidentiality Information about a candidate for testing or renewal of certification and CPHRM Examination results is considered confidential; however, the AHA-CC reserves the right to use information supplied by or on behalf of a candidate in the conduct of research. Studies and reports concerning candidates contain no information identifiable with any candidate, unless authorized by the candidate.

Demographic information about a candidate is shared only when beneficial to the candidate. Scores are never reported to anyone other than the candidate, unless the candidate directs such a request in writing.

Administrative MattersDuplicate CPHRM Examination score report A candidate may purchase additional copies of the score report for a fee of $25 per copy. The request must be submitted in writing to PSI and include the candidate’s name, unique identification number, mailing address, telephone number, and date the CPHRM Examination was completed as well as the $25 fee payable to PSI. After receipt of the request, the duplicate score report is mailed generally within about three weeks.

Score verification requestCandidates who do not pass the CPHRM Examination may request a manual verification of the computer scoring. Requests for manual scoring must be submitted to PSI in writing with a $25 hand scoring fee (cashier’s check or money order made payable to PSI) within one year following the CPHRM Examination date. The request must include your name, unique identification number, mailing address, CPHRM Examination date, and a copy of your score report. Please allow 10 business days for processing your request. Candidates close to passing are discouraged from a handscore request. PSI routinely samples examinations of candidates who score near passing to ensure correct reporting of results. These CPHRM Examinations are automatically handscored before results are mailed as a quality control measure. Thus, it is unlikely any CPHRM Examination results will change from “fail” to “pass” after a requested handscore.

Name and address changeCertificants are responsible for keeping current all contact information. The AHA-CC is not responsible for communication not received due to incorrect contact information. To update any contact information, please contact ASHRM at 312-422-3980 or the AHA Member Services Center at 312-422-2765.


RENEWAL OF CPHRM CERTIFICATION Achieving certification is an indication of mastery of a well-defined body of knowledge at a point in time. Periodic renewal of the certification is required to maintain certified status and to demonstrate ongoing commitment to remain current in the field. Initial certification or renewal of CPHRM certification is valid for three years.

Eligible candidates who successfully complete the CPHRM Examination are provided information about certification renewal requirements in a certification package sent by the AHA-CC. The CPHRM Certification Renewal Application must be submitted to the AHA-CC up to one year prior to the expiration date. For an additional nonrefundable fee of $50, certification renewals may be submitted up to 30 days past the expiration date.

As a courtesy, the AHA-CC sends notices to certificants of their pending certification expiration. Certificants are responsible for keeping their contact information accurate. The AHA-CC is not responsible for communications not received due to incorrect contact information in a certificant’s record.

The current CPHRM Certification Renewal Application and fees are available at www.AHACertificationCenter.org. A certificant shall renew the CPHRM credential through one of the following two ways: Successful re-examination. To renew this way, successfully pass the CPHRM Certification

Examination no more than one year prior to expiration of your CPHRM certification (subject to usual fees and provisions for testing). Submit to the AHA-CC the CPHRM Certification Renewal Application and a copy of your passing CPHRM Examination score report. An additional Certification Renewal Application fee is not required if a candidate selects this way to renew the CPHRM designation.

Completion of 45 contact hours of eligible continuing professional education over the three year period and payment of the renewal fee. To renew this way, submit a completed CPHRM Certification Renewal Application with the appropriate fee and report all eligible continuing professional education activities that you completed during your renewal period. Eligible activities include attending or teaching academic courses, completing on-line course, attending professional organization conferences and completing AHA-CC CPHRM Self Assessment Examinations, among other activities. Some activities have limitation on maximum allowable hours. Refer to the current CPHRM Certification Renewal Application for a description of eligible activities and other provisions for renewing your certification.

CPHRM Certification Renewal Application processing is generally about two weeks from receipt of application. Certificants who meet the renewal requirements receive in the mail (at the address in their membership record) a new certificate of recognition. Certificants are afforded an opportunity to remove deficiencies. Certificants are responsible for keeping current contact information in their membership record.


Failing to Renew CPHRM CertificationA certificant who fails to renew his or her CPHRM certification will receive written notification that he/she is no longer considered certified and may not use the CPHRM credential in professional communications including but not limited to letterhead, stationery, business cards, directory listings and signatures. To regain certification, the individual must retake and pass the CPHRM Examination (subject to the usual fees and provisions for testing).

APPEALSA candidate who believes he or she was unjustly denied eligibility for CPHRM Examination, who challenges results of a CPHRM Examination or who believes he/she was unjustly denied renewal of certification may request reconsideration of the decision by submitting a written appeal to the AHA Certification Center, 155 N. Wacker Drive, Suite 400, Chicago, IL 60606. The candidate for certification or renewal of certification must provide evidence satisfactory to the Appeal Panel that a severe disadvantage was afforded the candidate during processing of an application for CPHRM Examination or renewal of CPHRM certification or prior to or during administration of a CPHRM Examination. The appeal must be made within 45 days of receipt of a score report or any other official correspondence related to certification or renewal of certification from the AHA-CC or its agents. The written appeal must also indicate the specific relief requested. The appealing candidate is required to submit a $100 fee (payable to the AHA-CC) with the written appeal. The fee will be refunded to the candidate if deemed justified through action of the Appeal Panel. For additional regulations related to the appeal process, contact the AHA-CC.

Checklist for becoming certified Meet the CPHRM Certification Examination Eligibility Requirements.

Prepare for the CPHRM Certification Examination.

Read the CPHRM Candidate Handbook fully. Use the CPHRM Examination Content Outline to focus study efforts.

Apply for the CPHRM Examination by one of the following two ways:

- Mail or fax the complete CPHRM Examination Application to PSI as directed on the form. Include the CPHRM Examination fee, sign the application, and submit both pages of the application. When confirmation of eligibility is received from PSI, make an appointment to take the CPHRM Examination.

- Apply online for the CPHRM Examination and schedule an appointment to test on computer at a PSI Assessment Center. Visit www.AHACertificationCenter.org, click on “CPHRM,” “Online Application and Scheduling”, and then follow the online instructions.

Appear on time for the CPHRM Examination on the date and at the time and location selected. Bring the confirmation notice provided by PSI and identification as described in the CPHRM Candidate Handbook.


First Name Middle Initial Last Name

Facility/Company/Organization Title

Address City State/Province Zip Country

Phone Email

Former name if exam was taken previously under a different name

To apply for the CPHRM Examination, complete this CPHRM Examination application and return it with the examination fee to:

Applied Measurement Professionals, Inc., AHA-CC Examination, 18000 W. 105th St., Olathe, KS 66061-7543 FAX: 913-895-4651 PHONE: 888-519-9901

CANDIDATE INFORMATION

EXAMINATION TYPEPlace a checkmark next to the type of exam administration for which you are applying. Select only one. Computer administration at an PSI Assessment Center

Special domestic administration (For scheduled dates, see www.AHACertificationCenter.org.) Scheduled date:

International administration (For Request for International Examination Administration form, see www.AHACertificationCenter.org)

ELIGIBILITY REQUIREMENTS To be eligible for the Certified Professional in Health Care Risk Management (CPHRM) Examination, a candidate must fulfill one (1) of the following requirements for education/health care experience AND meet the requirement for risk management experience. By checking a box below, a candidate certifies to the AHA-CC that he or she satisfies the eligibility requirement. Check the one that applies.

Education/Health Care Experience Baccalaureate degree or higher from an accredited college or

university plus five (5) years of experience in a health care setting or with a provider of services to the health care industry

Associate degree or equivalent from an accredited college plus seven (7) years of experience in a health care setting or with a provider of services to the health care industry.

High school diploma or equivalent plus nine (9) years of experience in a health care setting or with a provider of services to the health care industry.

Risk Management Experience 3,000 hours or 50 percent of full-time job duties within the last

three (3) years dedicated to health care risk management in a health care setting or with a provider of services (e.g. consultant, broker, attorney) to the health care industry.

APPLICATION STATUS Check one of the following. I am applying as a new candidate.

I am applying as a re-applicant, i.e., retaking the test.

I am applying for renewal of CPHRM certification.

MEMBERSHIP STATUS If you are a current member of ASHRM or other AHA Professional Membership Group (PMG), you are eligible for the reduced CPHRM Examination fee. Please provide your 10-digit membership number below.

For information on joining the American Society for Health Care Risk Management (ASHRM), visit www.ASHRM.org. Membership must be obtained before application for examination at the reduced fee can be honored.

If you have applied for membership but have not yet received your membership number, enter “NEW” below. Membership Number: __ __ __ __ __ __ __ __ __ __

AMERICAN HOSPITAL ASSOCIATION CERTIFICATION CENTER CERTIFIED PROFESSIONAL IN HEALTH CARE RISK MANAGEMENT (CPHRM) EXAMINATION APPLICATION


CPHRM EXAMINATION FEES Payment may be made by credit card, company check, cashier’s check or money order made payable to PSI. Exam fees are nonrefundable and nontransferable.

Indicate the type and amount of fees enclosed: Member of ASHRM or other AHA PMG ........................$275

Nonmember .....................................................................$425

Rescheduling Fee ..............................................................$100

For payment by credit card, complete the following.Select type of credit card being used: VISA MasterCard American Express Discover

Credit Card Number

Expiration Date

Your Name as it Appears on the Card

Signature

SPECIAL ACCOMMODATIONS Do you require special disability related accommodations during testing? No Yes If yes, please complete the Request for Special Examination Accommodations form included in the Candidate Handbook. Submit it with this CPHRM Examination Application and fee at least 45 days prior to the desired testing date.

DEMOGRAPHIC INFORMATION The following demographic information is requested.

1. How many years of experience do you have in health care risk management?

0-5 years

6-10 years

11-15 years

16-20 years

21-25 years

26-30 years

More than 30 years

2. What is the highest academic level you have attained?

High school diploma or equivalent

Associate’s degree

Baccalaureate degree

Master’s degree

Doctoral degree

3. Professional designations earned (select all that apply):

ABHRM

AIC

ALCM

ARM

AU

CHEM

CHSP

CPA

CPCU

CPHQ

CSP

RN

RPLU

Other:

4. The majority of formal training you received in risk management was through:

College Courses

Professional Development (e.g., ARM, CPCU)

ASHRM Seminars/Certificate Programs

Other:

5. Current primary job function (select all that apply):

Acute Care Medical Center

Academic Medical Center

Multi-Hospital System

Specialty (e.g., pediatric, psychiatric, rehab.)

Long Term Care

Military/Federal/VA

Ambulatory Care

Insurance Company/Captive/Trust

Law Firm

Medical Group Practice

Home Health Care Agency

Risk Management Consultant

Other:

6. Current job title (Select one):

CEO/COO/CMO/CNO/CFO

Vice President/Chief Risk Officer

Medical Director

Risk Manager (e.g., coordinator, director, corporate)

Quality Assurance Manager (e.g., coordinator, director, corporate)

Patient Safety Officer

Claims Manager (e.g., coordinator, director, corporate)

Insurance Manager (e.g. coordinator, director, corporate)

Consultant

Attorney

Compliance Officer

Other:

SIGNATURE I certify that I have read all portions of the CPHRM Candidate Handbook and agree to abide by regulations contained therein. I certify that I am eligible to take the CPHRM Examination and the information I have submitted in this application is complete and correct to the best of my knowledge and belief. I understand that, if the information I have submitted is found to be incomplete or inaccurate, my application may be rejected or my CPHRM Examination results may be delayed or voided. Name (please print):

Signature: Date:

NOTE: Name, address, telephone number and email address of candidates who pass the CPHRM Examination are with ASHRM. Scores are never reported. If you do NOT wish to have your personal information shared, please opt out by contacting the AHA-CC in writing via e-mail at [email protected] or fax to 312-422-4575.


REQUEST FOR SPECIAL EXAMINATION ACCOMMODATIONSIf you have a disability covered by the Americans with Disabilities Act (ADA), please complete this form and the Documentation of Disability-Related Needs on the reverse side so your accommodations for testing can be processed efficiently. The information you provide and any documentation regarding your disability and your need for accommodation in testing will be treated with strict confidentiality. Please return this form with your CPHRM Examination application and fee to PSI at least 45 days prior to the desired testing date.

CANDIDATE INFORMATION First Name Middle Initial Last Name

Name of Facility/Company Title

Address City State/Province Zip Country

Phone Email

SPECIAL ACCOMMODATIONS I request special accommodations for the examination. Please provide (Check all that apply): Reader Extended testing time (time and a half ) Reduced distraction environment Large print test (paper-and-pencil administration only) Circle answers in test booklet (paper-and-pencil administration only) Other special accommodations (Please specify.)

Comments

PLEASE READ AND SIGN: I give my permission for my diagnosing professional to discuss with PSI staff my records and history as they relate to the requested accommodation.

Signed: Date:

ASHRM or other AHA Professional Membership Group Member (PMG) Number __ __ __ __ __ __ __ __ __ __ I am not a member of an AHA PMG.

Return this form with your examination application and fee to:Examination Services, PSI, 18000 W. 105th St., Olathe, KS 66061-7543

If you have questions, call PSI Examination Services at 888-519-9901 or fax to 913-895-4651.


Return this form with your CPHRM Examination application and fee to:Examination Services, PSI, 18000 W. 105th St., Olathe, KS 66061-7543

If you have questions, call PSI Examination Services at 888-519-9901 or fax to 913-895-4651.

DOCUMENTATION OF DISABILITY-RELATED NEEDSPlease have this section completed by an appropriate professional (education professional, physician, psychologist, psychiatrist, etc.) to ensure PSI is able to provide the required CPHRM Examination accommodations. The information provided will be treated with strict confidentiality. Return this form with the Request for Special Examination Accommodations form and your CPHRM Examination application and fee to PSI at least 45 prior to the desired testing date.

PROFESSIONAL ACCOMMODATIONS

I have know since / / in my capacity as a

Description of disability

Signed: Title:

Printed Name: Date:

License Number (if applicable)

Address:

Telephone Number: Fax Number:

Email:

DateExamination Candidate

Professional Title

www.AHACertificationCenter.org

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